Comparison of imaging methods for detection of simulated horizontal and oblique root fractures in a new study model

This study aimed to compare the accuracy of standard, mesially shifted, and distally shifted periapical radiography with that of cone beam computed tomography (CBCT) in detecting oblique and horizontal root fractures. Nine teeth were randomly divided into the control, horizontal root fracture (HRF), and oblique root fracture (ORF) groups. Fractures were created without fragment separation using a perpendicular force and confirmed by transillumination. The imaging techniques included standard periapical radiography (SP), mesially shifted periapical radiography (MP), distally shifted periapical radiography (DP), and CBCT. Four postgraduate dental students evaluated the images for the presence or absence of fractures using a five-point scale. The sensitivity, specificity, accuracy, and area under the receiver operating characteristic (ROC) curve were calculated for each observer. CBCT demonstrated higher sensitivity and accuracy than radiographic methods. ROC curve values were significantly greater for CBCT than for MP (p=0.005). For horizontal fractures, the sensitivity (p=0.125), specificity (p=0.630), and accuracy (p=0.201) showed no significant differences; however, the ROC curve area (p=0.003), favored CBCT. The inter- and intraobserver agreements ranged from moderate to substantial (0.45–0.78). The study model effectively simulated challenging root fractures without fragment discontinuation, and CBCT performed significantly better in detecting oblique root fractures.